AB0602 SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS IN ISRAEL: GENDER DIFFERENCES IN MANIFESTATIONS, MANAGEMENT AND COMORBIDITIES
Authors: T. Eviatar, V. Rosenberg, O. Elkayam, G. Chodick, D. Paran
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Prevalence, incidence, demographic and clinical characteristics of SLE are affected by race, ethnicity and socioeconomic status. The epidemiology of SLE in Israel is not well defined. <h3>Objectives</h3> We aimed to assess the prevalence of SLE and to describe the demographic and clinical characteristics of SLE patients. <h3>Methods</h3> A retrospective study using the computerized database of Maccabi Healthcare Services (MHS), a large health maintenance organization. Prevalent SLE patients on Dec 31 2020 were defined by: ICD-9 code 710.0 (≥2 diagnoses by a rheumatologist/immunologist and/or/≥3 diagnoses by a primary care physician/pediatrician and/or ≥2 diagnoses from a hospital); ≥1 a positive antinuclear antibody (ANA) test; ≥1 dispensed hydroxychloroquine (HCQ) prescription. All SLE patients were ≥10 years-old when first diagnosed; first diagnosed before Dec 31 2018; MHS members for ≥12 months before and ≥24 months after the first diagnosis of SLE. Patients diagnosed with dermatomyositis and/or systemic sclerosis were excluded. SLE patients were matched to controls from the general population of MHS members for age, sex and socio-economic status at a ratio of 1:5. <h3>Results</h3> We identified 1073 eligible SLE patients (prevalence rate of 55.6 per 100,000) and 5365 controls. The mean age on Dec 31 2020 was 50.7 (±14.9) and 942 SLE patients (87.8%) were female. Mean age at diagnosis was 37.2 (± 14.4). The prevalence of SLE disease manifestations is shown in Figure 1A. Since 2015 over 90% of SLE patients had ≥1 dispensed HCQ within 12 months of diagnosis, compared to only 50-70% among those diagnosed before 2015. In 2020 only 67.5% of the patients were still treated with HCQ, 24% were not taking any SLE medication, and 3.8% were treated with systemic glucocorticosteroids (GCs) alone. GCs were prescribed at least once for 74.8% of all patients, and for 30.8% in 2020. The median cumulative prednisone dose per disease year was 283 mg (IQR 0-1297.1), and was higher for males than females (630 mg [IQR 45-2028], 251.7 mg [IQR, 0-1183], respectively, <i>P</i> = 0.001). Compared to females, male SLE patients had a significantly higher prevalence of comorbidities (Figure 1B). Despite a similar prevalence of osteoporosis (OP) (<i>P</i>=0.828), use of OP medications was lower among men (M-16.2%, F-32.3%, <i>P</i> =0.046). Cardiovascular comorbidity and osteoporosis (OP) were more prevalent in SLE patients compared to controls (6.3% vs. 2.9%, respectively, <i>P</i> ≤0.001; (29.8% vs. 11.2%, respectively, <i>P</i> ≤0.001). <h3>Conclusion</h3> The prevalence of SLE in MHS in this study was found to be 1:1790. Prescription of HCQ within the first year after diagnosis has increased since 2015, however HCQ uptake decreased in the years following diagnosis, possibly due to waning compliance. GC cumulative doses were generally low, although it was three times higher in male than in female patients. Cardiovascular comorbidity and OP were more prevalent in SLE patients than in the general population, and more prevalent in male SLE patients, who usually bear a worse prognosis. Moreover, male SLE patients may be undertreated for comorbidities as manifested by higher GC doses and less OP treatment. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Tali Eviatar Consultant of: AstraZeneca, Vered Rosenberg Consultant of: AstraZeneca, Ori Elkayam: None declared, Gabriel Chodick: None declared, Daphna Paran Consultant of: AstraZeneca.